Drivers of Cost Variability of Ureteroscopy with Laser Lithotripsy at an Academic Institution

Ureteroscopy with laser lithotripsy (URS/LL) requires significant disposable equipment including wires, baskets, lasers, and stents. Surgeons choose this equipment based on preference, with higher- and lower-cost options available. We sought to explore factors that affect cost variability among urologists performing URS/LL within a single academic medical center. We retrospectively reviewed all patients who underwent URS/LL at our institution between September 2022 and June 2023. A weighted cost for each item's contribution to total cost was generated. Bivariate and then multivariate median regression models were generated to identify variables associated with higher total surgical cost. Statistical significance was considered p < 0.05. A total of 311 patients underwent URS/LL during the study period with 14 different surgeons. The total median cost of disposable equipment for the entire cohort was $1488/operation. On multivariate regression, basket cost above the cohort median or specialized catheter cost above the cohort median was associated with increased total surgical cost (p < 0.001). Fellowship training in endourology was associated with a decreased cost of $90.40 per case (p < 0.05). There is significant variability in the cost of ureteroscopy, even at a single institution where all surgeons have access to identical supplies. Attention to specific categories of equipment, which appear to be associated with higher total cost, as well as the potential differences in technique between surgeons with varied training, may help to identify opportunities for institutional cost savings.